Expandable nails were developed in order to eliminate operating time and radiation exposure. The authors present the results of the use of expandable nails in the treatment of long bone fractures.

Material and method: Fifty three patients (males females) 17 to 78 yrs of age, who suffered from 32 femoral, 5 humeral and 16 tibial fractures, were treated with the above technique. Three pts had ipsilateral femoral and tibial fractures, one a femoral and controlateral tibial fractures and three were grade II open. All patients received prophylactic anticoagualation. All but the open fracture patients have had three doses of antibiotics. The suitable candidate was a patient with a two part non comminuted fracture, although some degree of comminution was not a contraindication, provided there was at least 10 cm of intact bone beyond that comminution.

The mean operating time was 50 minutes (20 to 80 min) and fluoroscopy time 22 sec (from 0 to 45 sec). All but one fractures were united by week 16.5 for the femur, 14 for the humerus and 18.5 for the tibia.

Complications: A transient radial nerve palsy, two soft tissue (extra osseous) ossifications, one rotational malaligment, one pseudarthrosis due to failure of the nail to expand distally to the fracture site in a patient with controlateral tibial fracture, 1cm shortening, two fractures NOF and one non fatal massive pulmonary embolism. Fracture propagation was evident in 5 fractures, but further action was not needed.

Conclusions: Expandable nail system is a good alternative to classic locked IM, provided careful patient selection is done as well as thorough checking of nail distal expansion and fracture propagation. The reduction of the operating and fluoroscopy time opposed to lesser stability and greater cost.

The aim of the present study is to investigate if elbow extension in a supine position may be a diagnostic factor of signiþcant injury, in order to avoid unnecessary radiographs. Material and Method: Seventy patients, from 5 to 80 years of age, who suffered from an acute (< 6 hours) elbow injury, were examined in casualties. The inability to fully extend the elbow actively in a supine position, was deþned as a positive test. In order to avoid bias, the clinical examiner was the same and the radiographs were evaluated by a consultant radiologist, blinded to all clinical examination results. Sensitivity, speciþcity and positive and negative predictive values, along with their 95% conþdence intervals, were calculated for the elbow-extension test. Results: Forty out of seventy patients had a positive test. Elbow fracture or dislocation was identiþed radiographically in twenty-two patients with positive test. Only two out of thirty (with negative test) had a hairline radial-head fracture, which was found in the radiograph. Discussion: Based on the results of this study, the elbow-extension test has a high sensitivity of 92% and a speciþcity of 61%. The above clinical sign is valuable in the prediction of severe elbow injuries. Conclusions:the elbow-extension test can be considered as a sensitive screening test for acute elbow injuries. Patients with negative test may safely be treated without radiographic aid. Children with negative test may avoid useless radiological exposure.

The aim of the present study was to compare the amount of blood loss between Gamma nail and DHS operative procedures in treating fractures N.O.F.

Material and Method: thirty patients 81 years of age (average), suffering from N.O.F. fracture were divided in two groups, depending on sex, age, weight and type of fracture, in such way that for every patient operated using one procedure there was a similar one treated with the other one (pairing). The admission and discharge Ht, the blood unites needed for the whole patients hospitalization time were compared.

Statistically T-test, Pearson chi square – Fisher exact test were used.

Results: The average age for the Gamma nail group and DHS group were 82 yrs (sd=11,5) and 81,3 (sd=10,6), the admission Ht 36,9% (sd=4,0) and 36,72% (3,27) and the discharge Ht. was 33,2% (sd=2) and 34,9% (sd=2.9) respectively. For the first group (Gamma nail) 2.3 (sd=1.1) units of blood were used, compared to 2.4 (sd=0.7) for the second one (DHS). There was no statistical difference concerning the age and the population sample, the admission and discharge Ht, and the blood units needed between these two groups.

Conclusion: There is no difference concerning blood loss between Gamma nail and DHS in treating fractures N.O.F.